MEDICARE HMO is it right for you?

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Changing the way you receive and pay for health care is a very important decision and should be based on your own medical needs, financial situation, and personal values. If you are considering switching from Medicare fee-for-service coverage to an HMO plan, you should be aware of the possible advantages and tradeoffs.

Talk to any friends who belong to Medicare HMOs and ask your primary care doctor if he or she participates in any Medicare managed care plan; find out what their experience has been. Different HMOs offer different services, terms, and provider networks, and charge different premiums, copayments and deductibles. If more than one Medicare HMO plan is available in your area, you should review them and compare.

Carefully consider the advantages and disadvantages of enrolling in a plan if you travel a lot or live part of the year in another state. Important: Some plans provide coverage for a fixed period of time when you travel, others do not.

Since a Medicare HMO provides both Medicare and Medicare supplement insurance, you won't need any supplemental (Medigap) policies you may have. But you should check with your insurance company to see how your eligibility for a new supplemental policy may change if you enroll in a Medicare HMO and later drop out. You also may want to contact carriers of any specialty medical coverage you may have, such as long-term care or specified disease insurance, to determine if and how Medicare managed care may affect those policies.

HMO POSSIBLE ADVANTAGES
  • Preventive health care
  • Improved care coordination
  • Extra benefits, reduced costs
  • Less paperwork, simple payment system
HMO POSSIBLE TRADE-OFFS
  • Limits choice of doctors, specialists, hospitals, nursing homes and other service providers
  • May not be able to receive care from those you've been using for years
  • Limited coverage when traveling outside the service area

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